[Scan-DC] Arlington setting up landing zone

Tue May 12 13:32:49 EDT 2009

Great summary. I think it's fair to say that it's fair to question the use
of helicopters. Sometimes it makes sense, but sometimes they're used for
less-than-defensible reasons, as you point out.

-----Original Message-----
From: scan-dc-bounces at mailman.qth.net
[mailto:scan-dc-bounces at mailman.qth.net]On Behalf Of William Nicholson
Sent: Tuesday, May 12, 2009 1:02 PM
To: michael rumberg
Cc: scan-dc at mailman.qth.net
Subject: Re: [Scan-DC] Arlington setting up landing zone

    This exchange about helicopters is very interesting. I don't claim to be
the last word about anything. Perhaps, however, my experience during 15
years as an emergency medical provider, reaching the level of National
Registry Paramedic, in a suburban Washington, D.C. county might shed some
light on the subject. Here, in no particular order, are some observations:
     The attitude toward the use of medical helicopters is undergoing a sea
change, not just because of the tragic cost in lives of crashes and because
many are flown by for-profit companies under contract to hospitals. There
are increasing questions about how many of these flights are actually
necessary. It's not just because a number of people airlifted to trauma
centers walk out of those facilities hours late, which they do. It's also
because these patients are often saddled with tremendous transport bills --
thousands of dollars -- that their insurance companies sometimes balk at
paying.
    Where I practiced as a provider, medical control at the county hospital
changed protocols a couple of years ago to mandate that the physicians at
the other end of the phone or the EMS channel had to authorize a fly out.
So-called "mechanism of injury" would no longer suffice, because helicopters
were often being used willy-nilly. Some reasons: Fire suppression units
often arriving first at the scene have a Pavlovian urge to call the a
helicopter, even before an initial assessment of the patient, or patients,
has been done. Sometimes, inexperienced ambulance crews radio for a fly out,
in part because it's pretty exciting to be involved with a call like this.
Sometimes, an ALS provider just doesn't trust his or her skills to accompany
a patient by ground to the nearest trauma or burn unit. It's easier to golf
off the call to the helicopter.
     It's easy to call for a helicopter. Dispatch isn't going to argue about
it. That's not their job. But, once the ball is in motion, it's difficult
for a physician -- protocol or no protocol -- to wave it off and order
ground transport. I've seen it done. The doctor grills the provider about
exactly why a helicopter is needed; it's not pleasant to hear a provider
stammering as he or she tries to justify turning what should be a ground
transport into a helicopter ride. But some ER docs find it's easier to let
the call run its course and let the medevac proceed rather than possibly
face a lawsuit alleging negligence down the road. The medical director has a
tough job trying to educate providers and ER docs about when to use and when
not to use the fly out.
     Yes, the flight nurses and paramedics (the nurses are in charge) have a
high level of training, especially in RSI -- Rapid Sequence Intubation. This
is when paralytics are used in part to prevent a patient from bucking the
tube when being intubated. It also keeps the patient from struggling in the
cramped and dangerous environs of an aircraft in flight. But it is unfair to
say that ALS providers in ground transport units are somehow less capable,
especially in Northern Virginia. Just FYI, all ALS units in Northern
Virginia carry identical narcotics and paralytics in sealed packs that can
be swapped out at all participating hospitals. Ground ALS providers can and
do practice RSI, just not as often as flight crews do, for reasons given
above.
    Dual use helicopters, such as those flown by the U.S. Park Police,
Fairfax County and the Maryland State Police, have proven their worth.
Especially because they are often already in the air, on patrol. Most
civilian medevac helicopters are flown by commercial companies who contract
themselves out to hospitals. This takes nothing away from the skill of their
providers on board. But they are businesses. It's in their interest to fly.
And there can be some confusion about just how rapidly they respond to
calls. Some of the firms only count the time between lift-off and arrival on
scene. But there is lag time between when a dispatch center calls for a
helicopter and when it actually gets into the air. So, yes, there are
definitely times when a ground unit should be heading down the road, rather
than waiting for the bird to show up. This is especially relevant, for
example, at a traffic collision at 3 a.m. on or near a major highway. A
competent ALS crews -- and 99% of them are -- can provide high quality care
en route and be at the hospital before the helicopter shows up. Ground units
are far from meat wagons these days.
  Again, I'm not looking to one-up or flame anybody, nor do I claim to be an
authority on anything, but I thought it would be interesting to share some
of my experiences. Thank you.

On Tue, May 12, 2009 at 10:51 AM, michael rumberg
<m_c_rumberg at hotmail.com>wrote:

>
> I agree it appears ground transport would be faster at times and the FD is
> very aware of when it is and isnt.
>
>
>
> I dont know about the Aircare/Lifeflight helo procedures and timing, and
> certainly not the incident you referred to and why it took so long for the
> helo to be dispatched,  but for FCPD from opening the hangar doors and
> pushing out to the pad to being on site anywhere in the county takes less
> than five minutes.
>
>
>
> but it isnt simply a matter of drive time.  there is quite a "calculus" to
> determine if necessary or not.  I dont remember all the details but it
> includes the nature of the injury, what ground units are available, what
> medical center is available, what time of day/ground traffic is, etc.
>
>
>
> Also remember that one of the most important, if not the most important
> factor is the level of care the helo paramedic is trained, equipped and
> authorized to provide which is vastly higher than ALS medics and units.
>  These advanced procedures and medicines add tens of minutes to the
critical
> care time and just cannot be done on the ground.
>
>
>
> The helo medical care is higher than the ground units because the medical
> director has much more control over the helo medics and their training due
> to numbers.  There are hundreds of ground medics/paramedics but only a
> handful of helo medics (which are police officers BTW, not FD).  Because
> there are so few the medical director can actually interact with each one
of
> them during their training and evaluations which he cannot do with the
> hundreds of ground paramedics, resulting in the helo medics receiving the
> authorization to do more and use different medicines.
>
>
>
> so, the math becomes "watch my life slip away during the 15-20 minutes of
> waiting for  medical care while driving to the hospital" or "get 30
minutes
> added to your 'golden hour' by receiving the care I need immediately but
> arrive at the hospital 10 minutes later."
>
>
>
> they dont call them "meat wagons" for nothing.
>
>
>
>
>
>
>
>
> > From: lloydde at verizon.net
> > To: Scan-DC at mailman.qth.net
> > Date: Mon, 11 May 2009 20:17:04 -0400
> > Subject: Re: [Scan-DC] Arlington setting up landing zone
> >
> > I'm sure there is a better way (mobile trauma room), though I look back
> at
> > EMS and just having Paramedics is a HUGE improvement. It used to be that
> > Ambulances were just transport vehicles--now they are almost hospitals
on
> > wheels. I can definitely see where it would seem that air transport may
> not
> > seem the fastest option, though I offer:
> >
> > Usually (99%) of the time, a patient assessment is made and a chopper is
> > called before a rescue effort has begun... and it usually takes the full
> > time until the chopper gets on-scene before the patient is ready to be
> > transported. Listening on the scanner the time can seem like an
eternity.
> > There is a LOT of prep work that is required and usually involves just
> > extracting the patient from the wreck, which has to be done slowly to
> > prevent more injury. Also, there is a lot of patient care
(stabilization)
> > that is performed by the on-scene medics as well...
> >
> > Maybe I was lucky because Trooper 8 was right around the corner, though
I
> > can't imagine that other parts of the county were that much further
away.
> >
> >
> > David
> > -----Original Message-----
> > From: scan-dc-bounces at mailman.qth.net
> > [mailto:scan-dc-bounces at mailman.qth.net] On Behalf Of Andrew Clegg
> > Sent: Monday, May 11, 2009 19:30
> > To: Travis; scan-dc at mailman.qth.net
> > Subject: Re: [Scan-DC] Arlington setting up landing zone
> >
> > I have to presume that the first responders on this list know better
than
> I
> > do, but my experiences in listening to helicopter transports on the
> scanner
> > are more in line with what Travis says. By the time they've called for
> the
> > medevac, the thing has gotten in the air, they've scoped out a landing
> zone,
> >
> > they've packaged the patient in an ambulance for transport to the
landing
> > zone, they've driven to the landing zone, unloaded the patient from the
> > ambulance and put them in the helicopter, the helicopter takes off and
> flies
> >
> > to the hospital, the helicopter lands at the helipad, the patient is
> > unloaded, and finally gotten inside... the patient could have been there
> a
> > lot sooner by ground. Like Travis, I've heard incidents where it takes a
> > long time for all of this to transpire -- 45 minutes or more. And when
> the
> > incident is 10 miles or less by ground to the hospital, I could ride my
> bike
> >
> > to the hospital faster than the helo ultimately makes it there.
> >
> > I don't like to be counter-culture, but I really am having a hard time
> > buying the time-to-hospital arguments for helicopter transport here in
> the
> > city. Out in the rural areas and some of the far suburbs, it absolutely
> > makes sense. But in the middle of Arlington on a Sunday afternoon (for
> > example), I just can't buy it.
> >
> > Then you add all the safety problems these things have been having...
> >
> > ----- Original Message -----
> > From: "Travis" <freqhopping at earthlink.net>
> > To: <scan-dc at mailman.qth.net>
> > Sent: Monday, May 11, 2009 6:52 PM
> > Subject: Re: [Scan-DC] Arlington setting up landing zone
> >
> >
> > >
> > > ----- Original Message -----
> > > From: "michael rumberg" <m_c_rumberg at hotmail.com>
> > >
> > > 2. the helo is ridiculously faster transport - the helo can get to the
> > > hospital way before a ground unit. The FCPD helo can go from Reston to
> > > Mount Vernon in less than 5 minutes. As the crow flies 30 mph is WAY
> > > faster
> > > than an average speed of 60 mph on the ground. And quite frankly, an
> > > ambulance even after going on the beltway, will never actually get
> > > anywhere
> > > near a true average speed for the entire trip at 60mph - even if there
> > > really is "no traffic" on sunday afternoon.
> > >
> > > ___________________________________________
> > >
> > >
> > >
> > > This is not always the case. In many incidents I've listened to, a
> ground
> > > transport to Fairfax Hosp from Loudoun would've been faster. The most
> > > recent being the murder-suicide in Leesburg a few weeks ago. It was
> over
> > > an
> > > hour from the time units arrived on scene to the time the bird arrived
> at
> > > the hospital. The incident began before 5am. Aircare-3 was finally
> > > airborne from Leesburg airport at 5:30 as I left my driveway for work.
> I
> > > was in Tysons Corner 20 minutes later, another 5 and I could be at the
> > > hospital. I don't even have lights or sirens. I was sitting in my
> office
> > > for a while before Aircare flew by around 6:10 am.
> > >
> > > There's much more to it than point-to-point time. The bird has to get
> off
> > > the ground most of the time. That there can take 10-15 minutes. I can
> > > see
> > > Aircare-3 when it finally leaves Leesburg. Very rarely is it quickly
> > > after
> > > the request has been made. Then once they're on the ground there is a
> > > whole
> > > lot of packaging going on.
> > >
> > > The one reason why Fairfax-1 can respond so quick is because they are
> > > airborne much of the time without an EMS mission.
> > >
> > >
> > > Travis
> > >
> > >
> > >
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